2024 年 1 巻 5 号 p. 55-63
To evaluate the potential use of competency scales related to dietitians as a monitoring tool for students, we conducted a study on changes in dietitian competency scales over time within the progression of the curriculum. A self-administered questionnaire was conducted on 167 second-year students enrolled in the Registered Dietitian Training Program during their second and third years. The total scores for all competencies were significantly high during the transition period from the second to the third year of the program when students were transitioning from basic to applied professional courses. This indicates that Dietitian Competency Scale scores improved as the curriculum progressed. These findings suggest the potential use of the scale as a comprehensive assessment tool for regularly monitoring the qualities and competencies students should acquire by the time they graduate.
The development of the dietitian system in Japan during the Meiji Era (1868–1912) is regarded as a solution to address the challenges of inadequate nutrition caused by rapid modernization and food shortages. The dietitian system in Japan began in 1924 with the establishment of the School of Nutrition founded by Tadasu Saiki. Subsequently, in 1945, the Dietitian Regulations were introduced to establish the roles and responsibilities of dietitians. Further, in 1947, the Dietitian Act was enacted to define the profession and establish licensing requirements for dietitians. These systems established the qualifications of Registered Dietitians and Nutritionists
By the 1960s, the problem of insufficient nutrition resulting from food shortages had largely been resolved. However, concurrently, the process of Westernization and the adoption of a Western-style diet accelerated, leading to a significant rise in obesity due to overnutrition. This emerging issue became a prominent health and nutrition concern. In 1962, the Dietitian Law was partially amended to establish a system of dietitians with advanced knowledge and skills. Since then, the dietitian system has evolved to meet the changing needs. Currently, the system is licensed and dietitians are responsible for providing nutritional guidance for the treatment of injured and sick patients. The dietitian system necessitates collaboration with various professions in fields such as medicine, welfare, and health. This collaboration involves implementing practices such as “Additional Nutrition Management Practice” and “Additional Nutrition Support” within the medical field, nutrition care management within the welfare field, and specific health guidance in the health field1–3). In 2014, the Japan Dietetic Association revised its code of ethics for registered Dietitians and Nutritionists4). Along with the “Model Core Curriculum” proposed by the Japanese Society for Nutrition Improvement5), there is a need for highly qualified dietitians6) with advanced professional knowledge and skills. Furthermore, comprehensive training and support activities are essential to facilitate their growth.
Competency is a behavioral characteristic of individuals who demonstrate high performance, as proposed by McClelland in the United States7,8). Competency scales have been developed for various professionals in Japan and internationally to facilitate the advancement of human resource development9–12). In Japan, a competency scale for dietitians was developed by Nagai et al.13). at the pre-graduate level, with measurement items including professional awareness and practical skills14–17). Students who possess a strong foundation in occupational awareness and basic competencies often conduct graduation research and subsequently secure employment or pursue further education upon graduation14). However, assessment of the basic competency scale for dietitians is currently confined to final-year students nearing graduation. Further, there remains a lack of comprehensive understanding regarding the influence of curriculum progression on competency development.
The “Grand Design for Higher Education Toward 2040”18) emphasizes the importance of learner-oriented education and the cultivation of well-rounded individuals with expertise in their respective fields of study. These individuals should also have a solid foundation in critical thinking, judgment, a holistic perspective, and effective communication skills. They should acquire a broad range of knowledge in liberal arts, uphold a high sense of public responsibility and ethics, and actively contribute to society by applying logical thinking in response to evolving societal needs. Its objective is to cultivate human resources with the ability to actively support and improve society through logical thinking. In pursuit of these goals, methods of evaluating learning in higher education have been discussed. As part of these efforts, the “Guidelines for Teaching and Learning Management”19) have been introduced. It is necessary to present “what students can learn and acquire” and to monitor and comprehensively evaluate the qualities and abilities to be acquired by graduation on a daily basis.
Therefore, the aim of this study was to assess the viability of using a competency scale for dietitians as a monitoring tool for students and to examine changes in the dietitian competency scale over time throughout the curriculum.
If the competency scale proves effective as a monitoring tool for students, determining their achievement level will become more straightforward. This, in turn, will facilitate the provision of tailored educational support based on individual achievement levels. We anticipate that this approach will enhance the training of dietitians to a higher standard.
Dietitians have diverse employment opportunities, spanning hospitals, government positions, and businesses20). A broader and more advanced cadre of dietitians in society will contribute to improving access to healthy food and information across various contexts. Consequently, we posit that dietitian training plays a role in preventive medicine.
A survey was conducted with 167 second-year students enrolled in the Registered Dietitian Training Program at University A. The competency scales utilized in this study were originally designed for students in their graduation year. However, we focused on second-year students who had completed Specialized Basic Fields (Table 1), in this study. These second-year students have completed the Specialized Basic Fields. They have established common competencies (Ethical Attitudes and Research, Nutrition and Food Skills, and Nutrition Management Skills), enabling them to respond to the majority of the questions.
| Educational Contents | 1 year | 2 year | 3 year | 4 year | |
|---|---|---|---|---|---|
| Specialized Basic Fields | Society, Environment and Health | Public Hygiene Practice in Public Hygiene Introduction to Social Welfare |
Environmental Science | ||
| Structure and function of the human body and the development of diseases | Anatomy and Physiology I Practice in Anatomy and Physiology I Biochemistry I |
Anatomy and Physiology II Practice in Anatomy and Physiology II Biochemistry II Experiment in Biochemistry Clinical Medicine I |
Clinical Pathogenic Microbiology Clinical Medicine II Practice in Clinical |
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| Food and Health | Food Science Experiment in Functional Food Science |
Experiment in Food Science Experiment in Food Processing Functional Food Science Food Hygiene Experiment in Food Hygiene Culinary Science Experiment in Culinary Science |
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| Special Fields | Basic Nutrition | Basic Nutrition | Experiment in Basic Nutrition | ||
| Applied Nutrition | Applied Nutrition I Applied Nutrition II Applied Nutrition III |
Practice in Applied Nutrition | |||
| Nutrition Education | Nutrition Education I Nutrition Education Theory II Practice in Nutrition Education I |
Nutrition Education Theory III Practice in Nutrition Education II |
|||
| Clinical Nutrition | Clinical Nutrition I Clinical Nutrition II |
Clinical Nutrition III Clinical Nutrition IV Practice in Clinical Nutrition I Practice in Clinical Nutrition II |
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| Public Health Nutrition | Public Health Nutrition I Public Health Nutrition II Practice in Public Health Nutrition |
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| Food Service Management | Food Service Management I | Food Service Management II Practice in Food Service Management |
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| Comprehensive Exercise | Comprehensive Exercise in Nutrition and Dietetics I Comprehensive Exercise in Nutrition and Dietetics II | ||||
| Clinical Practice | Clinical Practice I | Clinical Practice II Clinical Practice III |
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The assessment was conducted on two occasions: first, in the second year (February 2020, following the completion of the second semester) and then in the third year (October 2020, following the conclusion of the first semester). The survey comprised a self -administered questionnaire that used a mark sheet and a set method. The collected mark sheets underwent a thorough review to identify and rectify any errors, such as duplicate responses and contamination. Only mark sheets deemed valid were scanned using a scanner (Scan Snap ix500, Fujitsu).
2) Survey ContentThe survey comprised competency measurement items for dietitians at the pre-graduate education level and an overview of the participants (e.g., age, sex etc.). For the items measuring competency at the pre-graduate level, we used a questionnaire developed by Nagai et al.13). Comprising 40 items designed to measure the competencies of dietitians among students.
Competencies comprise three components: basic competencies (related to professional awareness), common competencies (related to professional practice), and area-specific competencies (related to specialized knowledge and skills). The basic competencies comprised four items related to professional awareness as a dietitian: values, self-belief, motivation, and attitude (one item each). Common competencies comprised three components: “ethical attitude and research” (B1, 8 items), “nutrition and food skills” (B2, 10 items), and “nutrition management skills” (B3, 11 items). The questionnaire had 29 items. The job-specific competencies consisted of seven items related to the specialized knowledge and skills required in each job area: “public nutrition” (C1, 3 items), “clinical nutrition” (C2, 3 items), and “food service management and administration” (C3, 1 item). Participants self-evaluated and scored themselves on a 5-point scale for the 40 questions. Table 2 provides details of the question items, with higher scores indicating greater awareness and competence.
| 2nd year | 3rd year | p-value | |||
|---|---|---|---|---|---|
| Mean ± Standard deviation | (Median) | Mean ± Standard deviation | (Median) | ||
| A: Basic Competency | 15.53 ± 2.93 | (16.00) | 15.69 ± 2.65 | (16.00) | 0.549 |
| Value: Proud to be a Registered Dietitian | 4.00 ± 0.91 | (4.00) | 4.06 ± 0.85 | (4.00) | 0.339 |
| Self-conviction: I am suited to the profession of Registered Dietitian. | 3.10 ± 0.83 | (3.00) | 3.01 ± 0.78 | (3.00) | 0.121 |
| Motivation: To contribute to people’s health and happiness through food | 4.22 ± 0.86 | (4.00) | 4.36 ± 0.83 | (5.00) | 0.037 |
| Attitude: I want to improve my professional knowledge and skills as a Registered Dietitian | 4.22 ± 0.91 | (4.00) | 4.26 ± 0.81 | (4.00) | 0.897 |
| B: Common Competency | 30.37 ± 5.45 | (30.00) | 33.98 ± 5.16 | (98.00) | <0.001 |
| B1: Ethical Attitudes and Research | 25.66 ± 4.43 | (26.00) | 26.74 ± 4.20 | (27.00) | <0.001 |
| Build good relationships and networks through effective communication. | 3.57 ± 0.81 | (4.00) | 3.74 ± 0.85 | (4.00) | 0.025 |
| Recognize your assigned role and collaborate with other professions with mutual understanding. | 3.61 ± 0.75 | (4.00) | 3.65 ± 0.75 | (4.00) | 0.610 |
| Provide ethical considerations (such as respect for human rights, informed consent, and protection of personal information) to patients, clients, and residents. | 3.48 ± 0.90 | (4.00) | 3.69 ± 0.86 | (4.00) | 0.023 |
| Collect statistical information on health and nutrition to determine the current status. | 3.07 ± 0.78 | (3.00) | 3.18 ± 0.80 | (3.00) | 0.164 |
| Obtain and use evidence-based information from papers and reports in related fields. | 2.99 ± 0.88 | (3.00) | 3.14 ± 0.79 | (3.00) | 0.134 |
| Gather information on medical and nutritional issues, as well as food and environmental issues in society. | 3.36 ± 0.83 | (4.00) | 3.42 ± 0.79 | (3.00) | 0.425 |
| Plan and conduct research studies to solve individual and community nutrition issues. | 2.84 ± 0.87 | (3.00) | 3.05 ± 0.74 | (3.00) | 0.009 |
| Select and analyze appropriate tabulation and statistical methods for data obtained through research studies. | 2.74 ± 0.84 | (3.00) | 2.89 ± 0.79 | (3.00) | 0.100 |
| B2: Nutrition and Food Skills | 19.21 ± 4.76 | (20.00) | 21.31 ± 4.04 | (34.00) | <0.001 |
| Understand and explain the energy balance of the human body and the function and metabolism of each nutrient | 3.11 ± 0.85 | (3.00) | 3.18 ± 0.81 | (3.00) | 0.375 |
| Understand food ingredients and characteristics, and prepare and cook menus | 3.07 ± 0.73 | (3.00) | 3.52 ± 0.84 | (4.00) | <0.001 |
| Prepare menus according to the subject’s life stage, lifestyle, preferences, eating function, etc. | 3.04 ± 0.76 | (3.00) | 3.59 ± 0.72 | (4.00) | <0.001 |
| Ensure proper sanitation, including prevention of food poisoning | 3.42 ± 0.83 | (4.00) | 3.71 ± 0.73 | (4.00) | <0.001 |
| Understand food standards and safety regulations and systems and explain how to prevent health hazards | 2.83 ± 0.75 | (3.00) | 2.99 ± 0.76 | (3.00) | 0.074 |
| Grasp the current status of laws, regulations, and systems related to health, medical care, welfare, and health promotion | 2.93 ± 0.77 | (3.00) | 3.15 ± 0.74 | (3.00) | 0.009 |
| Utilize the Dietary Reference Intakes to prevent over- or under-intake of energy and nutrients by the subject (target population) | 3.39 ± 0.83 | (3.00) | 3.77 ± 0.77 | (4.00) | <0.001 |
| Understand the characteristics of food composition tables and use them in menu planning and nutrition education | 3.22 ± 0.79 | (3.00) | 3.65 ± 0.75 | (4.00) | <0.001 |
| Utilize behavioral science theories and models to promote behavioral change in the target population | 2.68 ± 0.82 | (3.00) | 3.26 ± 0.85 | (3.00) | <0.001 |
| Utilize counseling skills to promote acceptance of the subject’s situation and behavioral change | 2.67 ± 0.86 | (3.00) | 3.16 ± 0.82 | (3.00) | <0.001 |
| B3: Nutrition Management Skills | 88.76 ± 14.96 | (91.00) | 97.73 ± 13.53 | (37.00) | 0.005 |
| Select and implement dietary survey methods appropriate to the purpose and subject and use them for assessment | 2.95 ± 0.81 | (3.00) | 3.33 ± 0.77 | (3.00) | <0.001 |
| Assess the subject/eater’s knowledge, attitudes, and behaviors related to food | 3.05 ± 0.80 | (3.00) | 3.46 ± 0.71 | (4.00) | <0.001 |
| Select and implement assessment methods appropriate to the subject’s physical condition and objectives | 2.92 ± 0.79 | (3.00) | 3.27 ± 0.68 | (3.00) | <0.001 |
| Determination of representative biochemical values in blood and urine for assessment | 2.86 ± 0.85 | (3.00) | 3.13 ± 0.91 | (3.00) | 0.004 |
| Utilize information from interviews, medical records, nursing records and vital signs for assessment. | 2.62 ± 0.80 | (3.00) | 3.14 ± 0.82 | (3.00) | <0.001 |
| Identify issues that need to be improved in diet from the results of the assessment | 3.13 ± 0.79 | (3.00) | 3.63 ± 0.63 | (4.00) | <0.001 |
| Determine priorities among issues and set goals for improving diet | 3.10 ± 0.75 | (3.00) | 3.58 ± 0.68 | (4.00) | <0.001 |
| Develop a plan to achieve your goals for improving your diet | 3.14 ± 0.81 | (3.00) | 3.57 ± 0.69 | (4.00) | <0.001 |
| Provide nutrition education according to the life stages and lifestyles of the target population | 3.07 ± 0.81 | (3.00) | 3.38 ± 0.66 | (3.00) | <0.001 |
| Monitor and evaluate progress during and after plan implementation | 2.94 ± 0.77 | (3.00) | 3.22 ± 0.69 | (3.00) | <0.001 |
| Review and revise the plan as necessary based on the evaluation | 2.94 ± 0.75 | (3.00) | 3.29 ± 0.69 | (3.00) | <0.001 |
| C: Competency by Job Category | 32.73 ± 6.88 | (33.00) | 37.00 ± 5.61 | (21.00) | <0.001 |
| C1: Public Nutrition | 7.85 ± 2.16 | (8.00) | 8.51 ± 2.08 | (9.00) | <0.001 |
| Assess the community based on epidemiological concepts. | 2.58 ± 0.82 | (3.00) | 2.78 ± 0.79 | (3.00) | 0.016 |
| Identify social resources needed to address nutrition issues in the community. | 2.66 ± 0.77 | (3.00) | 2.90 ± 0.76 | (3.00) | 0.002 |
| Develop improvement plans to address nutrition issues in the community, including health promotion and improving the food environment. | 2.61 ± 0.76 | (3.00) | 2.83 ± 0.79 | (3.00) | 0.005 |
| C2: Clinical Nutrition | 8.62 ± 2.18 | (9.00) | 9.70 ± 1.88 | (9.00) | <0.001 |
| Understand the role of healthcare professionals and explain the role of the dietitian. | 2.97 ± 0.86 | (3.00) | 3.20 ± 0.79 | (3.00) | 0.011 |
| Prepare menus and suggest meal plans based on the patient’s medical condition and nutritional status. | 2.88 ± 0.81 | (3.00) | 3.30 ± 0.68 | (3.00) | <0.001 |
| Provide nutritional guidance based on the patient’s medical condition and nutritional status. | 2.78 ± 0.81 | (3.00) | 3.20 ± 0.68 | (3.00) | <0.001 |
| C3: Food Service Management | 2.74 ± 0.91 | (3.00) | 3.10 ± 0.77 | (3.00) | <0.001 |
| Provide meals to a large number of people (ordering, purchasing, inspection, storage, mass cooking, sanitation, etc.). | 2.74 ± 0.91 | (3.00) | 3.10 ± 0.77 | (3.00) | <0.001 |
*Wilcoxon’s signed Signed Order Test
The statistical program package IBM SPSS Statistics 25.0, (IBM) was used for statistical analysis, with a significance level of less than 5% (two-tailed test). Wilcoxon’s signed-rank test was used to compare the evaluations in the second and third years.
4) Ethical ConsiderationsThe Research Ethics Committee of Mukogawa Women’s University approved this study (Approval No. 20–42). Before the survey, the purpose and methodology of the study were explained orally and in writing (research descriptions). Consent was obtained from the participants by requesting them to fill out the questionnaire using their names.
Of the 167 survey participants, 151 (90.4%) responded to the second-and third-year surveys. A total of 23 respondents with no names or incomplete responses were excluded, and 128 (76.6%) who responded to both surveys were included in the analysis. The mean age of the subjects was 19.84 ± 0.47 years, and all participants were female.
The basic competencies score was significantly high in the third year for “wanting to contribute to people’s health and happiness through food,” reflecting motivation. However, there were no significant differences in the overall scores for the basic competencies.
The total score for common competencies increased significantly in the third year, along with the total scores for the three components, from B1 to B3. “Respect for human rights, informed consent, and protection of personal information,” and “planning and researching to solve individual and community nutrition problems” showed significant improvement in the third year. Moreover, nine out of ten items in B2 had significantly high scores in the third year, except for “understanding and explaining the energy balance of the human body and the function and metabolism of each nutrient.” Further, all items in B3 showed significant improvement in the third year.
The total score of job-specific competencies and that of the three components C1–C3 were both significantly high in the third year. Additionally, the scores for all C1–C3 components were significantly high in the third year (Table 2).
This study aimed to investigate changes over time in the Competency Scale for Dietitians from the second to the third year. The results showed that the attainment levels of common competencies were higher than those of basic and job-specific competencies. Among the common competencies, the achievement levels for items B2 and B3 were particularly high. As these items are knowledge and skills that can be acquired through the campus curriculum, it can be assumed that the achievement level of these competencies increased as students advanced to the next level. However, item B1, which included ethical considerations, communication with others, and the ability to gather information on evidence and social issues, included knowledge and skills that are challenging to acquire through the academic curriculum. Nevertheless, the self-assessment of item B1 may have been underestimated due to the assumption of basic knowledge and skills already acquired as a registered dietitian. Therefore, enhancing educational support is necessary to increase students’ self-efficacy as they progress through the curriculum.
Regarding basic competency, Akamatsu et al. reported14) that the median basic competency score of fourth graders was 16, with a range of 14 to 17 (25–75 percentile). These findings indicate that participants in this study demonstrated a high level of achievement in basic competencies. However, the increase in achievement level resulting from curriculum progression was relatively small compared to that observed in common competencies. As University A offers a three-credit curriculum focusing on clinical practice and research activities in the fourth year (Table 1), we anticipate that the completion of these courses will contribute to the further enhancement of basic competencies by the time of graduation. Considering that the early acquisition of basic competencies fosters motivation in learning attitudes and enhances job-specific competencies, it is vital to provide introductory education and educational support to help each student develop a clear professional vision as a dietitian.
Based on the survey results of changes in the Dietitian Competency Scale over time as the curriculum progressed, we evaluated the potential use of the Dietitian Competency Scale as a tool for monitoring students. The survey results showed that the competency scale for dietitians improved as the curriculum progressed. Competency scores could increase similarly whether they are followed up through the fourth grade. Previous reports have suggested the limited use of competency scales for dietitians for evaluation only at the point of graduation. However, our study indicates the possibility of using competency scales as a comprehensive evaluation tool for routine monitoring of the qualities and abilities that students should acquire before graduating. Therefore, using the competency scale as a comprehensive assessment tool for evaluation at the time of graduation and for regular monitoring of students’ progress toward acquiring the necessary qualities and abilities is essential. We need to explore avenues for offering personalized educational support based on competency scales to students aspiring to become registered dietitians. We are confident that such personalized support will cultivate highly skilled dietitians capable of making significant contributions to preventive medicine.
Notwithstanding, this study has the following limitations. First, the study was conducted solely within the one-year follow-up period, spanning from the second year to the third year. This timeframe is particularly significant as it corresponds to when students are undergoing their introductory education as dietitians and transitioning from basic specialized subjects to applied specialized subjects. This occurs when competency improves the most. Second, the target population of this study was limited to female students from a single institution. Third, the study was not conducted in conjunction with other evaluations using the GPA or other methods. The Competency Scale for Dietitians is a self-assessment tool. As the evaluation of competencies typically involves assessments by others, it will be crucial to conduct a comprehensive evaluation in the future utilizing measures such as GPA and other assessment methods.
This study evaluated the potential use of a competency scale for dietitians as a monitoring tool for students. Further, it investigated changes in the dietitian competency scale over time as the curriculum progressed. The study found that the dietitian competency scale improved as the curriculum progressed, indicating its potential use as an assessment tool at graduation and as a comprehensive tool for routinely monitoring the qualities and competencies that students should acquire before graduating.
We would like to express our sincere gratitude to all the participants in this study and to Dr. Kayoko Maeda, Dr. Mikako Kishimoto, Mr. Masao Kawamura, and Dr. Yasuko Fukuda of Mukogawa Women’s University for their guidance.
Koichi Hayashi and Sakiko Tamaki made major contributions to the conceptualization of the study. Yuuki Nishimura, Naoto Otaki, Chihiro Toji, Aya Ogawa, Yorika Matsuda, and Masaki Enshouiwa contributed significantly to data analysis and interpretation. Sakiko Tamaki made significant contributions to the preparation of the manuscript. All authors critically reviewed and revised the manuscript and approved the final version for submission.
There are no conflicts of interest to disclose regarding this study.
